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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER IIUILDER DEI,CARATION
<br />I hcrcby alltnr undcr p.nalr, {,, pcriny rhai I !'n cr.nrpr rroN rhc conta.tnc Liccnsc tj, lor rhe r'ollowins rca$i (scc 70ll 5
<br />Buqhc\s n l Pofc\si.n Cdc): Atry Ciry or C.utrry whi.h rcqutcs r fcmi lo con{ocr. alrcr. inurorq &ift,li\h .r rc,)an any
<br />srdchrc, lrhr ro ns hsu.ncc. rho rcquncsrhc rlplicid fo, such pcmir ro nh ! sig.cd{!rc@nr rh h.or sho li.ctrrd pursu{nl
<br />t) rhc ptuvishn\ of rhc Contr.ror's Li.ctrscd tj* (Ch{rcr 9. Comnrncin8 wirh Sc.rion 7lxn of Dilhn,n 3 .f rhc aurn.s j.d
<br />tftntsions Codc) or lnar tEorsnc i\ crcnul rhcrcftrnn and rhc Msi\ IhrrhcrlkEcdcrcnFri.n Anyviolrrio.ofScdionT0.ll5hyrn,
<br />rmli.anr ror rNrmir srhjNhrhc applrn ro tr.rvilpctrrhyormr nmrcrhin nlc hundrcd dnlhrs(S5m)
<br />l, rs owncr.Ilhc nroltrny. o. nrycnrployccr *ilh w.Scs rs Ihcn soh c.mncnslri,tri. silldo ihc work dM rhc (nrlurc is ftn
<br />i'nc&hd or orlercd fn slc lSr-. 70.1.1. Br\ines md tliofcsi,,n\ Co.l.: Thc Coikr.ttr s t-icensc Lrs docs nor apply n, an osmr.f
<br />rhc[Jpcdy whohuildsor iltllnrtr$Ih.rmf. lnd who dcs such sodr hi scllorhcr{llorrhrtughhi\orhdrowic[!lo]ccs,
<br />pmv .d rlrr such irpmvcnr \ cR inrcndd or olltr.d tbr e!. lf, ho{d.r. rlt hiklin8 nr nnprovcnrN t $ld $irhn onc }flr
<br />olconlilelior. rhc Osncr Buildcr qillhs'! rhc h,.dcn olproving rhrl] hc.r \hc did n.r build or i']llmrt rhc m,Ilny li)r rh. r'urrx,s ot
<br />l. n\.sncrofrhc pn,p{ny. rnicrchsiv.ly.ontr.ri'rE wnh liccnsrd.otrt..rtrs ki.otrNr.r lhc nn)rcd lScc 7O4'r. Bu\itc\r
<br />r PNf$snn Codc:l-hc Conr.lcroi\ Liccn{ l-aw do.s nor alrply ro ano*mr ofln)r.dy wh. btrrlds or imp.ovcs rhcrcon.
<br />rrd who cotr!,r.r\rorsuchrmj.ctsNirh. A,nh.ro(r) lrcDscd lur$rnrk,lhcConrrocrois l-iccnsc l2w)
<br />P*loLr!rr,
<br />Iltlt !!!.!r!^
<br />Ihcrch, fln'n ututor l.irlryol,lcrjury otrc ofrltc
<br />lhuldrdwilltuimdiriC.nifi.0tcofconscnlh)sclflnsurcfDrwortcmcomDcnsrrion.u\pn,vidcdfubyseri.nlT0oolthc
<br />L!ho. Codc. forrhe pc{onMn.c of th. *o* f.r whi.h rhc pdnir i\ k\ncd.
<br />I harr.nd*illnki rin workcF comncns ion lNurrncc. is rcqutcd 6y Scclion -17fi) oflh. hhlr Codc,lor lhc pcnbnnrmc ol'
<br />rh. {orkrDrshi.hrlis p$nril is nsucd Mysorkcrs L_ompcn$riotr ir*urlo.ccnnidr Lftl F,li.y nu.$cr d.:
<br />-lccniiyrhalinrhcpcraorromcofrhcsorkforlhihrhtpcrrnir
<br />n i\\u.d.I shtrlltror c (iy rny ncron io aot nr mr
<br />v, r\ t tf,com \!hj.rr h rh. solkfl .unll.tr\d im lae\ of Crlif.nrir. ind l8re rhal il I \lould hccon{ suhr.r ro rhc
<br />*orlrA compcnsrrion pmrtion\.lS.cr6n l7U)ofrhc lrhtr Corlc.ldmll. i)nhwirh.onuly qirh rho{ rn,vni.rs*r\R\l\(; l htrr nr \.Lur! tr.rr..^ com|ltr \ tr"|.N'u|,.trJ.1" I r hr, r .' -rr.i r._'..." trul r-r,I...".',,r,,,' 1.... ..r',.,'r.*,r""',r,.," - ".,. ','q' '",,'. v L li',c\ nf ni otu l,trn(lr.,l rhou\ n1l ,lollx^ ll
<br />Scdn,n .ll)74 olrhe lrtnr Codc, inrcrcn aid anorm,
<br />8.-t u('\) tlut k <-.JaIt)li( t,,\R r llr)\
<br />of rhc Eusincs r d P(nr\sn,i\Crdc. dd ry I'ccr\c N d tulllitr.c M ctacr
<br />TQNIBUCIIQNIEIDINC-&AINCI
<br />I hcrcby flrlirnruMcr rcnrlryolNrjury rhlr lhcrc n ! onirucri'n hnditrs ascn.y ror rh. ncrronMrcc olthc wo.k for shth ihn p.nnn is
<br />hsucd (sN 1097. civ c ).
<br />AITLUANI.IIE!;IAAAIIO!
<br />I bRnyruinnu c' rcnalty of!.rjury.nc orrhr lall(,ai'rt d.chrarionl:
<br />Dcw'liitnr Per iG A$cdo\ Norificari.n F.d.hlRc8ultrrid,\ (Iirlc 40. Ptd6)
<br />Roqrnrd Irrrrr or Norili.rro
<br />I.crrlirlltrhcl.dcrlrcg(ldionrr.grnlinEr\l,c{.\r.nn)vrltr'ctr.rxp,,licrhlcr)rl,\Doiccr
<br />_l.crrifyrhl(Ihrvcrc ihisrDrlicrri{n,rndnncrl rthcJhi\rinln rtni n..nc.r lrgrLrlocorntly {irh rll(iry nd(iiodr!
<br />hdrcbyaurhrizc rcprcscnrirn$ ol lhn Cilylnd.rlirtrn!c\.'nd Sr. c L'tri rcbriu/" huillins -,n{d.ri,,n. J
<br />fi\c nr n rcd nmNnr lhr m"/"oi"nnun-*,
<br />n,,,n*, - n*-, *n-,./-f U UlA U
<br />Pomi,eDme,prin,,, /4t lt" t t w' 5()l,-),,rc,ElK(Le-./< l)
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorivent/l nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />t
<br />FINAL q llqil't ,*rLl
<br />Certif icate ol Occupancy l
<br />N otes, Remarks, Etc.
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